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Individual
DR. MICKEY E. GORDON
Active
Individual
DR. MICKEY E. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
0936
MI
213E00000X
Podiatrist
187
NM
213E00000X
Podiatrist
Primary
PO2638
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0936
PODIATRIC MEDICAL LICENSE
MI
01
—
187
PODIATRIC MEDICAL LICENSE
NM
01
—
5782609
AETNA PROVIDER #
FL
01
—
65543
BC/BS PROVIDER #
FL
01
—
K6801
MEDICARE ID
FL
01
—
PO2638
PODIATRIC MEDICAL LICENSE
FL
Enumeration date
01/23/2006
Last updated
03/31/2008
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